EAQ peds
What sexually transmitted diseases are caused by bacteria? Select all that apply. 1 Syphilis 2 Hepatitis 3 Gonorrhea 4 Herpes simplex 5 Trichomoniasis
Syphilis is caused by Treponema pallidum, a motile spirochete bacterium. Gonorrhea is caused by a bacteria called Neisseria gonorrhoeae. Hepatitis A and herpes simplex are caused by viruses. Trichomoniasis is caused by a protozoan.
A nurse is reviewing the laboratory values of a school-aged child with rheumatic heart disease. Which finding does the nurse conclude is related to this condition? 1 Negative C-reactive protein 2 Increased reticulocyte count 3 Positive antistreptolysin titer 4 Low erythrocyte sedimentation rate
A positive antistreptolysin titer is expected with rheumatic fever because of a previous streptococcal infection. A positive, not a negative, C-reactive protein reading is expected with rheumatic heart disease. A positive C-reactive protein reading is indicative of an inflammatory process. An increased reticulocyte count is unexpected. An increased reticulocyte count is usually related to anemia, which stimulates the bone marrow to produce so many red blood cells that more immature blood cells (reticulocytes) enter the circulation. The erythrocyte sedimentation rate is increased, not decreased, with rheumatic heart disease, indicating the presence of an inflammatory process.
A 6-year-old child comes to the well-child clinic for a routine examination. The nurse identifies black lines on the teeth at the gum line. What does the nurse suspect as the cause of this finding? 1 Perthes disease 2 Lead poisoning 3 Salicylate toxicity 4 Tetracycline administration
Black lines on the teeth at the gumline are a common finding in lead poisoning (plumbism). They are caused by the deposition of lead. Perthes disease is characterized by pain and hip dysfunction. Salicylate toxicity affects the eighth cranial nerve, causing tinnitus. Neonatal tetracycline administration may cause yellow-brown discoloration of the teeth. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
What would be the drug of choice in an adolescent who is diagnosed with gonorrhea and wishes to continue breast-feeding? 1 Azithromycin 1 g 2 Amoxicillin 500 mg 3 Ceftriaxone 250 mg 4 Ceftriaxone 125 mg
Ceftriaxone 250 mg is the standard drug treatment used in lactating women suffering from gonorrhea. Azithromycin and amoxicillin are used in lactating women suffering from syphilis. Ceftriaxone 125 mg is used in nonpregnant women suffering from gonorrhea.
The parents of a school-aged child with newly diagnosed celiac disease ask a nurse what the intestinal biopsy revealed. Before responding in terms that the parents will understand, what should the nurse consider about the results of the biopsy? 1 The mucosal wall exhibits trophic changes. 2 There is diffuse degenerative fibrosis of the acini. 3 The mucosal wall has small areas of fatty plaques. 4 There are irregular areas of superficial ulcerations.
Celiac disease is a primary defect in which the intestinal mucosal transport system is impaired; the inability to digest gluten results in an accumulation of glutamine, which is toxic to mucosal cells and causes atrophy of the villi. The pancreatic acini degenerate with cystic fibrosis, not with celiac disease. Small areas of fatty plaques on the mucosal walls and irregular areas of superficial ulceration do not occur in celiac disease. Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early.
On the second day after sustaining extensive severe burns a 6-year-old child exhibits edema and decreased urine output. For which additional adverse response should the nurse assess the child in this early stage of burn injury? 1 Bradycardia 2 Disorientation 3 Subnormal temperature 4 Systolic blood pressure of 100 mm Hg
Disorientation may be an initial indication of dehydration or an early sign of hypoxia resulting from respiratory complications. Tachycardia, not bradycardia, is usually associated with the early phases of burn injury. A fever, not a subnormal temperature, is associated with burns because of the increased basal metabolic rate. The systolic blood pressure range for a 6-year-old child is 95 to 110 mm Hg. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.
Two siblings who live in a camp for migrant workers have contracted measles. The nurse, trying to determine which individuals had contact with the children, identifies those with immunity and assesses the probability of containing the measles to the camp. What technique has the nurse used in managing this situation? 1 Nursing process 2 Incidence process 3 Probability process 4 Epidemiological process
Epidemiological process is a term given to the set pattern of procedures followed in the community when the health of the public is threatened by a communicable disease. The nursing process may be used as part of the investigation, but the scope of the problem extends beyond nursing. Incidence process is incorrect terminology for this assessment. Evidence-based nursing is a more appropriate term, but the scope of the problem extends beyond nursing. Probability process is incorrect terminology for this assessment. Risk factor is a more appropriate term for this assessment, but it is not relevant to the technique being used.
An 18-year-old adolescent male complains of painful urination and yellow-green mucosal discharge from urethra not associated with abdominal pain. What condition is the client likely to have? 1 Varicocele 2 Testicular torsion 3 Epididymitis 4 Gynecomastia
Epididymitis is a condition characterized by dysuria, pyuria, scrotal pain, redness, and swelling. Epididymitis is not associated with gastrointestinal symptoms as in testicular torsion. Varicocele is a condition characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle which is not associated with urethral discharge. Gynecomastia has no symptoms of abnormal urethral discharge.
A 5-year-old kindergartner asks to go to the bathroom almost every hour. What is the most important question to ask when the school nurse calls the mother to inquire about this problem? 1 "Has your child had a physical lately?" 2 "Does your child wet the bed at night?" 3 "Does your child have a short attention span?" 4 "Has your child been going to the bathroom often at home?"
If this behavior persists outside school as well, the nurse may pursue a physical examination to test for possible problems such as a urinary tract infection or diabetes. Asking about a physical may eventually be done, but it is not the priority question. Frequent urination at home, not uncontrolled urination at night, is information that should be obtained from the parent first; enuresis can occur in boys even without a urinary tract infection. A short attention span is not related to the presenting problem.
An adolescent client is reported to have inflammatory acne lesions. Which medication would the primary healthcare provider prescribe? 1 Tazarotene 2 Isotretinoin 3 5% dapsone gel + adapalene 4 Erythromycin + benzoyl peroxide
Inflammatory acne lesions involve the presence of papules, pustules, and nodules. A 5% dapsone gel coupled with a topical retinoid such as adapalene is used to treat inflammatory acne lesions. Erythromycin is used in combination with benzoyl peroxide to treat inflammatory lesions that accompany comedones. Tazarotene alone is not used to treat inflammatory acne lesions. Isotretinoin is used to treat severe cystic acne in clients who do not respond to other topical treatments. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
The nurse assesses a 5-year-old child after a shunt procedure is performed to correct increased intracranial pressure. Which finding is of most concern? 1 Marked irritability 2 Complaints of pain 3 Pulse of 100 beats/min 4 Temperature of 99.4° F (37.4° C)
Marked irritability may be a sign of malfunction of the shunt or infection and should be reported immediately. Complaints of pain are expected after surgery. A pulse rate of 100 beats/min is within the expected range (70 to 110 beats/min) for children between the ages of 2 and 10 years. A low-grade fever is expected after the stress of surgery.
Immediately after being placed in the supine position, an adolescent child experiences shortness of breath and must sit up to breathe. What term should the nurse use to document this clinical phenomenon? 1 Apnea 2 Dyspnea 3 Orthopnea 4 Hyperpnea
Orthopnea is shortness of breath in any position except the erect, sitting, or standing position. Apnea is a temporary cessation of breathing. Dyspnea is labored or difficult breathing regardless of the position. Hyperpnea is an increased respiratory rate, not shortness of breath. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.
An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How should the nurse respond when the client complains of pain and requests medication? 1 By withholding the medication to help prevent addiction 2 By stating that the limb has been removed and that the pain is psychological 3 By acknowledging that the pain is real and administering medication to relieve it 4 By explaining that the phantom limb sensation will subside within a few more days
Pain medication is required, along with intensive supportive nursing care. To the client the pain is real, requiring pain medication; addiction is not a concern at this time. Explaining that the pain is psychological in origin does not help relieve the pain; medication and emotional support are required. The pain may not recede within a few days; pain medication should be administered.
A child returns to his room after left-side cardiac catheterization. What is involved in the postprocedure nursing care? 1 Encouraging early ambulation Correct 2 Monitoring the insertion site for bleeding 3 Comparing blood pressures in the two extremities 4 Restricting fluids until the blood pressure has stabilized
Postprocedure hemorrhage, a life-threatening complication after cardiac catheterization, is possible because arterial blood is under pressure and the catheter has entered an artery. Rest will be encouraged; flexion of the insertion site should be avoided to prevent disturbance of the clot. Comparing blood pressures in the two extremities is unnecessary; the pulse distal to the catheterization insertion site is monitored. The blood pressure will not be unstable unless a problem develops; fluid intake should be encouraged.
A nurse is teaching preadolescents about puberty. What should the nurse tell them about the primary sex characteristics? Correct 1 They are related to reproduction. 2 They develop at the same rate in most adolescents. Incorrect 3 Each sex is identified by the primary sex characteristics. 4 Primary sex characteristics are apparent before secondary sex characteristics.
Primary sex characteristics are those that are related directly to reproduction—the release of an ovum from the ovaries in a female and the development of viable sperm in a male. The rate of pubertal development varies from adolescent to adolescent. Secondary sex characteristics are those related to maleness (e.g., pubic, axillary, and facial hair; deepening of the voice; increased muscularity) and femaleness (e.g., pubic and axillary hair, breast development). Primary sex characteristics are not apparent before secondary sex characteristics.
What instructions should the nurse give to an overweight adolescent to help him or her lose weight? Select all that apply. 1 Skip breakfast. 2 Sleep for long hours to reduce stress. 3 Perform physical activities regularly. 4 Eat small frequent meals throughout the day. 5 Reduce the intake of sugar and sweetened beverages.
Regular physical activities can reduce risk factors associated with obesity and help a client lose weight. Eating small frequent meals throughout the day can increase a client's metabolism and help with weight reduction. Excess intake of sugar and sweetened beverages increases obesity. Sleeping for long hours increases the risk of obesity. Breakfast should not be skipped.
What instructions should a nurse provide to adolescent boys regarding the usual procedure to be followed and normal findings observed during testicular self-examination. Select all that apply. 1 A firm, smooth, egg-shaped organ can be palpated. 2 Each testicle is examined individually after relaxing the scrotal skin. 3 A hard mass that can be palpated on anterior or lateral aspect of testicle. 4 The thumb and fingers of both hands can be used to apply firm and gentle pressure. 5 A raised swelling that can be palpated on the superior aspect of the testicle is the epididymis.
Testicular self-examination is usually performed after a warm bath when the scrotal skin is relaxed. A firm organ with smooth and egg shaped contours that can be palpated is the testicle. Each testicle is examined individually using thumb and fingers of both hands applying firm and gentle pressure. A raised swelling that can be palpated on the superior aspect of testicle is the epididymis. Testicular cancer can be suspected if a hard mass can be palpated on the anterior or lateral aspect of testicle.
A nurse in the pediatric unit is admitting an 8-year-old child with asthma after an exacerbation at home. The child is short of breath. In what position should the child be placed to facilitate breathing and to promote respiratory drainage? 1 Supine 2 Left lateral Correct 3 High-Fowler 4 Trendelenburg
The high-Fowler position gives the lungs more room to expand, thereby promoting respiration and affording more comfort. The supine, left lateral, and Trendelenburg positions will all increase dyspnea; they do not permit chest expansion.
What should a school nurse's first action be when a child reports a sore throat? 1 Examine the throat. 2 Have the child sent home. 3 Take the child's temperature. 4 Secure a prescription for an oral analgesic.
The priority is to assess the throat to determine the extent of inflammation. Significant swelling can create the potential for airway obstruction. Assessment of the child's problem must be done before initiating any other actions.
A female adolescent complains of breast pain. Which antigonadotropic herb may alleviate breast pain by decreasing prolactin levels? 1 Catnip 2 Black haw 3 Bugleweed 4 Chaste tree fruit
Bugleweed is an herb used to decrease breast pain by decreasing prolactin levels and facilitating an antigonadotropic effect. Black haw and catnip are herbs that act as uterine antispasmodics. Chaste tree fruit also decreases breast pain by decreasing prolactin levels, but it is not antigonadotropic.
How does sexual identity aid psychosocial development in the adolescent? Select all that apply. 1 It helps them evaluate their own health. 2 It helps develop masculine and feminine behaviors. 3 It helps them feel a sense of admiration and acceptance. 4 It helps them develop decision-making and budgeting skills. 5 It helps them lessen the feeling that they are different from peers.
Physical evidence of maturity encourages the development of masculine and feminine behaviors and enhances sexual identity in the adolescent. Sexual identity assuages the adolescent's fear of being different from his or her peers. Adolescents depend on sexual clues because they want assurance of maleness or femaleness and do not wish to be different from their peers. Health identity helps the adolescent evaluate his or her own health. A group identity helps the adolescent develop a sense of being admired and accepted. A peer group provides the adolescent with a sense of belonging and approval and the opportunity to learn acceptable behavior. A family identity helps the adolescent develop decision-making and budgeting skills.
A nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. What does the nurse expect analysis of the child's urine to reveal? 1 High protein level 2 Low specific gravity 3 Numerous red blood cells 4 Several crystalline particles
Protein (albumin) is present in the urine of children with nephrotic syndrome; it is evidence of kidney damage. Proteinuria, combined with oliguria, results in an increased urine specific gravity. Only rarely do red blood cells (RBCs) or RBC casts filter through the glomerular basement membrane. Crystals are not found in the urine of children with nephrotic syndrome.
A nurse is caring for a school-aged child who has had a tonic-clonic seizure. How should the nurse describe the clonic phase? 1 Generalized rigidity 2 Loss of consciousness 3 Spasmodic body jerking 4 Tremors of upper extremities
The clonic phase of a tonic-clonic seizure is associated with the rapid rhythmic extension and relaxation of muscle groups throughout the body. Rigidity occurs during the tonic phase of a seizure. Loss of consciousness is not specific to the clonic phase; it occurs at the beginning of the tonic phase and continues into the clonic phase. The movements during the clonic episode are more marked than the movements of a tremor and occur throughout the body, not just in the extremities. Test-Taking Tip: Get a good night's sleep before an exam. Staying up all night to study before an exam rarely helps anyone. It usually interferes with the ability to concentrate.
According to the Erikson's theory, which stage describes the will of an adolescent to achieve a goal? 1 Initiative versus guilt 2 Integrity versus despair 3 Intimacy versus isolation 4 Identity versus role confusion
The stage of identity versus role confusion is the fifth stage of development as per Erikson's theory. During this stage, identity development begins with the goal of achieving some perspective or direction. The initiative versus guilt stage is the third stage of Erikson's theory. During this stage, children like to pretend and try out new roles. The integrity versus despair stage is the eighth stage of Erikson's theory. At this stage, many older adults view their lives with a sense of satisfaction. The development of sense of care in a young adult occurs at the stage of intimacy versus isolation. This is the sixth stage of development according to Erikson's theory. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.
A 5-year-old child is admitted to the pediatric unit for an appendectomy. What question should the nurse ask to determine what the child thinks is the reason for hospitalization? 1 "What are you doing at the hospital?" 2 "Have you brought any toys with you?" Incorrect 3 "Did your parents tell you why you're here?" 4 "Did you know that you're going to have an operation?"
The first option is a direct question that should elicit the desired information. The other questions can be answered with a yes-or-no response and do not elicit what the child knows or feels about the situation. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.
A 10-year-old girl with diabetes joins the school's soccer team. Her mother is unsure whether to tell the coach of her child's condition. The mother asks the school nurse for guidance. On what information should the nurse base the response? 1 Children with diabetes who participate in active sports can have episodes of hypoglycemia. 2 Children may have to leave athletic teams if school authorities learn that they have diabetes. 3 The school nurse will treat the child if clinical findings of hypoglycemia are recognized early. 4 The coach might violate confidentiality by discussing the child's condition with other faculty members.
The people associated with the school who are interacting with the child should be told about the child's condition. Knowledgeable people can be alert for early signs of hypoglycemia and have snacks available for the child to help prevent a hypoglycemic episode. Forcing the child to leave the team is a form of discrimination; children with diabetes are allowed to engage in activities as long as their diabetes remains under control. The adult who is with the child when the signs of hypoglycemia first appear should be prepared to treat the child; this person may or may not be the nurse. Information about the child's health status is on a "need to know" basis; professionals are expected to honor confidentiality.
An 8-year-old child is admitted to the emergency department with signs and symptoms of Reye syndrome. What information from the child's history is most important for the nurse to obtain in light of the child's tentative diagnosis? 1 Recent rash 2 Tonsillitis attacks 3 Recent viral infection 4 Recurrent high fevers
There is a strong relationship between Reye syndrome and an antecedent viral infection, especially one treated with aspirin. Rash, tonsillitis, and high fever are not specifically related to Reye syndrome. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment.
A preschooler is admitted with a diagnosis of acute glomerulonephritis. The child's history reveals a 5-lb (2.3 kg) weight gain in 1 week and periorbital edema. How can the nurse obtain the most accurate information on the status of the child's edema? 1 Weighing daily 2 Observing body changes 3 Measuring intake and output 4 Monitoring electrolyte values
Weight monitoring is the most useful means of assessing fluid balance and changes in the edematous state; 1 L of fluid weighs about 2.2 lb (1 kg). Visual inspection is subjective and generally inaccurate. Measuring intake and output is not as accurate as daily weights; fluid may be trapped in the third compartment. Monitoring of electrolyte values is unreliable; they may or may not be altered with fluid shifts.
After a 5-year-old child's tonsillectomy, the nurse notes that the child swallows frequently. What should the nurse conclude about the child's behavior? 1 This is a sign of respiratory distress. 2 The child is experiencing throat pain. 3 The child is bleeding from the surgical site. 4 This is a reaction from the general anesthesia.
A trickle of blood from the surgical site will cause the child to swallow frequently; usually this is the first sign of hemorrhage. If the child were experiencing respiratory distress the clinical manifestations would include dyspnea, tachycardia, and changes in behavior or skin color. The child with a sore throat tries not to swallow. Frequent swallowing is not a usual response on awakening from general anesthesia.
An adolescent girl with a seizure disorder refuses to wear a medical alert bracelet. What should the nurse tell the girl that may help her wear the bracelet consistently? 1 Hide the bracelet under long-sleeved clothes. 2 Wear the bracelet when engaging in contact sports. 3 Ask her friends to wear bracelets that look like hers. 4 Select a bracelet similar to bracelets worn by her peers.
Because adolescents have a developmental need to conform to their peers, the teenager should be able to select a bracelet of a design similar to that of those worn by her peers. Hiding the bracelet under long-sleeved clothes might be acceptable in cool weather, but not when it is warm and friends are wearing T-shirts. The bracelet should be worn at all times when the girl is not with responsible family members. Asking friends to wear a similar bracelet may be difficult, especially if the girl does not wish to tell her friends why she needs the bracelet.
A school nurse is teaching a class of school-aged children about bicycle safety. The nurse determines that a child needs further teaching when the child makes which statement? 1 "I will always wear a helmet and ride with traffic facing me." 2 "I will always wear a helmet and walk my bike to cross busy streets." Incorrect 3 "I will always wear a helmet and keep as close to the curb as possible." 4 "I will always wear a helmet and stay in a single file when I ride with my friends."
Bicyclists are required to follow the rules of the road; they must ride with traffic, obey traffic signs and lights, and signal when turning. Walking the bicycle at intersections, riding close to the curb, and staying in single file all help prevent accidents.
A 5-year-old child with a ventricular septal defect (VSD) is scheduled for cardiac catheterization. The parents ask the nurse why this test is being done. While formulating a reply, what does the nurse recall is the function of the test? 1 Identifies the specific location of the defect 2 Confirms the presence of a pansystolic murmur 3 Reveals the degree of cardiomegaly that is present 4 Establishes the presence of ventricular hypertrophy
Cardiac catheterization visualizes the exact location of the ventricular septal defect; also it measures pulmonary pressures. A murmur can be heard with a stethoscope placed at the left lower sternal border. Cardiomegaly and ventricular hypertrophy are both demonstrated on electrocardiography and echocardiography.
A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and got a positive result. She confides that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl whether she has told anyone else, she replies, "Yes, but my mother doesn't believe me." Legally, who should the nurse notify? 1 Police concerning a possible sex crime 2 Primary healthcare provider to confirm the pregnancy 3 Child protective services for immediate intervention 4 Girl's mother about the pregnancy test's positive result
It is the nurse's legal responsibility to report child abuse to the appropriate agency. Safety is the priority, and child protective services will provide immediate intervention. Although the police may be notified, this is not the nurse's responsibility at this time. Notifying the primary healthcare provider may be done later, but it is not the priority. The girl's pregnancy has not been confirmed; at this time it is most important to protect her and her sisters.
A 9-year-old child with leukemia is to be discharged home on a protocol that includes several antineoplastic medications. What should the nurse plan to teach the parents? 1 Use an electric toothbrush to provide meticulous oral care. 2 Limit the child's contact with peers to avoid exposure to infections. 3 Withhold the antineoplastic medications when vomiting occurs to prevent additional episodes. 4 Notify the practitioner if the child has a temperature of 100° F (37.8° C) to obtain an antibiotic prescription.
The child with a low white blood cell count does not show the usual signs of infection, including fever, inflammation, and drainage. Any low-grade temperature or other subtle sign or symptom must be reported immediately so an antibiotic may be prescribed. An electric toothbrush may damage the oral mucous membranes; a soft toothbrush or mouth swabs should be used to cleanse the mouth. Children with leukemia undergo therapy for extended periods, and prolonged isolation from their peers may result in destructive social isolation. The exposure to peers depends on the child's white blood cell levels and an absence of signs and symptoms of infection in the peer. Nausea commonly occurs with this therapy. Antiemetic measures usually are instituted, but the chemotherapeutic medication is continued. Withholding of medication should be discussed with the practitioner.
Which method of contraception may provide adolescents with the longest duration of protection? 1 NuvaRing 2 Levonorgestrel implant 3 Spermicidal suppositories 4 Levonorgestrel intrauterine system
The levonorgestrel intrauterine system is a T-shaped intrauterine system which releases levonorgestrel. It must be placed within seven days of menses and provides protection up to five years. The NuvaRing, a flexible, soft, and transparent ring placed in the vagina, must be replaced every three weeks. The levonorgestrel implant is a small rod that provides protection for up to three years. Spermicidal suppositories are inserted into the vagina to kill sperm and provide protection for only a short duration.
At which stage of Kohlberg's theory does an individual show societal concerns? 1 Stage I 2 Stage II 3 Stage III 4 Stage IV
According to Kohlberg's theory of moral development, at stage IV the individual expands focus from a relationship with others towards societal concerns. At stage I, the child is afraid of punishment. A child in this stage reasons, "I must follow the rules; otherwise I will be punished." At stage II, the child recognizes that there is more than one right view. At stage III, the child wants to win approval and maintains the expectations of one's immediate group. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers.
Which nutrient deficiency in the pregnant adolescent may result in decreased birth weight as a consequence of low bone mineral density in the fetus? 1 Zinc 2 Iron Correct 3 Calcium 4 Folic acid Calcium and vitamin deficiency may result in decreased birth weight as a consequence of low bone mineral density. Zinc deficiency may not lead to a decrease in bone mineral density. Iron deficiency may lead to anemia. Folic acid deficiency may result in neural tube defects.
Adequate inspection of the feet should become a habit; it is the quickest and easiest means of identifying pressure sites and preventing infection. Hot water should never be used, because it may cause burn injury of the skin. The feet should be patted dry, not rubbed; rubbing may cause abrasions and injure the skin. Strong antiseptics are too harsh and should not be used because they may cause injury to the skin. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
An adolescent sustains a sports-related fracture of the femur, and open reduction and internal fixation with a rod insertion is performed. After the surgery, a nurse notes that the adolescent is very upset. In light of the client's developmental level, what does the nurse conclude is the most likely explanation for this distress? 1 The need to navigate in a wheelchair 2 The perception that the rod is a body intrusion 3 Inability to participate in sports for several years 4 The necessity of medication for pain relief until the bone heals
Adolescents are concerned about body image and fitting in with a peer group; the stabilizing rod may be viewed as an insult to the intactness of the body. The nurse should obtain additional information to confirm this assumption. Weight-bearing can be prevented with crutches, which provide greater mobility than a wheelchair. Adolescents who undergo open reduction and internal fixation with a rod insertion generally return to normal activities after several months. Although pain may be a concern, an adolescent is old enough to understand that analgesics are available; this probably is not the reason that the adolescent is upset. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.
What nursing actions are appropriate for an adolescent girl undergoing a pelvic examination? Select all that apply. 1 Teach the adolescent about hygiene, body function, and sexuality. 2 Invite the adolescent's parent in the examination room. 3 Postpone giving details about an exam as it may arouse fear in the adolescent. 4 Encourage the discussion of safer sex practices. 5 Display drawings, models, and equipment to help educate the adolescent.
Adolescents are often apprehensive about a pelvic examination. During the pelvic examination, the nurse should give the adolescent information regarding hygiene, body functions, and sexuality. Drawings, models, and equipment should be displayed to better educate the adolescent. In addition, the nurse should discuss safer sex practices, sexually transmitted infection prevention, and the postponing of sexual activity until the adolescent feels emotionally ready. The adolescent's parents should not be invited without the adolescent's consent.
A nurse educates a group of parents about the psychosocial changes of adolescents. Which statement made by parents indicates inadequate learning? 1 "Adolescents search for personal identity." 2 "Adolescents establish close peer relationships." 3 "Adolescents love their parents in every situation." 4 "Adolescents wish to be independent while keeping good family ties."
Adolescents tend to love or hate their parents depending on the situations. Adolescent psychosocial development involves a search for personal identity. Adolescents may establish close peer relationships or remain socially isolated. Adolescents strive for emotionally independence from their parents while retaining family ties.
A nurse is obtaining the health history of a 7-year-old child admitted to the pediatric unit with signs and symptoms suggestive of Reye syndrome. What, in the child's recent history, indicates a specific precursor to Reye syndrome? 1 Body rash 2 High fever 3 Viral infection 4 Allergic reactions
Although the cause is unknown, there is a strong relationship between Reye syndrome and an antecedent viral infection such as varicella and the use of aspirin as an analgesic. A rash is not specific to Reye syndrome; a rash may have other causes. A fever may also have other causes. Allergic reactions have no relationship to Reye syndrome. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
A primary healthcare provider suspects ectopic pregnancy in an adolescent and conducts further evaluation. Which signs and symptoms have led the provider to suspect ectopic pregnancy? Select all that apply. 1 Hypotension 2 Abdominal pain 3 Vaginal bleeding 4 Cervical abnormalities 5 Maternal systemic illness
An adolescent girl with hypotension and abdominal pain may have an ectopic pregnancy that has ruptured, and emergency surgery may be indicated after prompt evaluation. When an adolescent girl experiences vaginal bleeding and abdominal pain, ectopic pregnancy must be ruled out. Cervical abnormalities and systemic maternal illness may lead to spontaneous abortion, but they do not signal ectopic pregnancy. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options are likely related to the situation, but only some of the options may be related directly to the situation.
A nurse working at a summer camp is informed of an outbreak of scabies. What is the classic symptom of scabies for which the nurse needs to assess the children? 1 Pruritic threadlike lesions in skin folds 2 Grayish-white particles adhering to hair shafts 3 Central necrotic ulcer surrounded by petechiae 4 Reddened, round areas of alopecia over the scalp
As the mite burrows into skin folds (e.g., interdigital, axillary, inguinal), it creates threadlike burrows that are intensely pruritic. Grayish-white particles adhering to hair shafts are nits, an indicator of pediculosis capitis, not scabies. A central necrotic ulcer surrounded by petechiae is not an indicator of scabies; this is the bite of a brown recluse spider, which results in a lesion that progresses to necrotic ulceration in 7 to 14 days. Reddened areas of alopecia are consistent with ringworm, not scabies. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.
A nurse in the pediatric clinic is assessing an 8-year-old child who has had asthma since infancy. What clinical finding requires immediate intervention? 1 Barrel chest 2 Audible wheezing 3 Heart rate of 105 beats/min 4 Respiratory rate of 30 breaths/min
Audible wheezing that is heard without a stethoscope is an indication that the airways are significantly compromised, and this requires immediate medical intervention. Barrel chest is a sign of chronic asthma. Repeated attacks result in a fixed hyperaerated thoracic cavity; this clinical finding does not require intervention. A heart rate of 105 beats/min is expected in an 8-year-old child, as is a respiratory rate of 30 breaths/min. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the "old" material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don't wait until the middle to end of the semester to try to cram information.
A nurse is reviewing the healthcare provider's prescriptions for a school-aged child with diarrhea caused by a Salmonella infection. Which prescription should the nurse question? 1 Stool for occult blood 2 Oral rehydration therapy 3 Bismuth subsalicylate (Kaopectate), 2 teaspoons after each stool 4 Acetaminophen (Tylenol), 15 mg/kg for temperature above 101° F (38.3° C)
Bismuth subsalicylate (Kaopectate) has adsorbent and demulcent effects; stool will stay in the intestine longer, which will allow the organism to infect the intestinal mucosa. Diarrheal stools should be tested for occult blood to determine whether the upper gastrointestinal tract is affected. Oral rehydration therapy is an appropriate intervention because it will replace fluid and electrolyte lost in diarrhea. Acetaminophen (Tylenol) should be administered to promote comfort if the child has a fever.
A nurse is teaching a 12-year-old child about a bone marrow aspiration. What statement indicates that the preadolescent needs further explanation of the procedure? 1 "I'll have to rest after the procedure." 2 "My hip will be sore after the procedure." 3 "You'll put a tight bandage on me where the needle goes in." 4 "The doctor is going to stick a needle into the middle of one of my hip bones."
Bone marrow aspiration generally involves the use of conscious sedation; activity is usually not restricted after a child recovers from the sedation. In addition to conscious sedation, the healthcare provider will probably use a local anesthetic. The child should not feel discomfort, pain, or pressure while the bone marrow is being withdrawn, but there may be some discomfort after the procedure once the sedation/anesthetic wears off. A tight dressing prevents bleeding from the puncture site. The anterior or posterior iliac crest is the site most often used for bone marrow aspiration in children.
A 5-year-old child undergoes cardiac catheterization. The child is in the post-cardiac catheterization unit for 2 hours when the incoming nurse receives the report from the outgoing nurse. Which part of the child's report should the incoming nurse question? 1 Vital signs every 30 minutes 2 Voided 100 mL since admission 3 Pressure dressing over entry site 4 Bed rest with bathroom privileges
Children are kept on complete bed rest for 4 to 6 hours after cardiac catheterization to reduce the risk of bleeding or trauma at the insertion site; the report regarding bathroom privileges should be questioned. Frequent assessment of vital signs is part of routine postcatheterization care. Urine output of 100 mL is within acceptable limits for a child of this age; oral fluids are encouraged to promote hydration and urination. A pressure dressing is placed over the insertion site to prevent bleeding. This is routine postcatheterization care. Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specified time limits, you should pace yourself during the practice testing period accordingly. It is helpful to estimate the time that can be spent on each item and still complete the examination in the allotted time. You can obtain this figure by dividing the testing time by the number of items on the test. For example, a 1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed test. Both the number of questions and the time to complete the test varies according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question equals 1.3 minutes.
A school nurse is screening kindergarten children for color vision deficit (color blindness). What should the nurse consider before speaking to the parents of a color-blind child? 1 Color blindness is not familial. 2 More boys than girls have the deficit. 3 Equal numbers of children of both sexes are color blind. 4 Children who have the deficit usually have other vision problems.
Color blindness is a sex-linked deficit that occurs more frequently in boys. There is a familial link with color blindness. Boys are more likely than girls to be color blind. Other vision problems are not related to color blindness.
A 6-year-old child with acute spasmodic bronchitis who is receiving humidified air removes the mask, and while bathing the child the nurse notes increasing respiratory distress. What is the most appropriate nursing intervention? Correct 1 Stopping the bath and replacing the mask 2 Performing postural drainage and clapping the chest 3 Placing the child in the orthopneic position and calling the practitioner 4 Suctioning the child's nasal passages and waiting for the dyspnea to subside
Interrupting the bath and providing humidified air will reduce energy requirements, allow the child to rest, and lessen the demand for oxygen. Although postural drainage loosens secretions in the lungs, it should not be used when the child is in distress. The orthopneic position will not reduce energy and oxygen demands; the healthcare provider should be called if appropriate nursing measures do not relieve the dyspnea. Suctioning is not performed unless respiratory distress is severe; it increases restlessness and energy demands. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.
What over-the-counter drugs are used to treat vulvovaginal candidiases? Select all that apply. 1 Tinidazole 2 Miconazole 3 Clotrimazole 4 Azithromycin 5 Metronidazole
Miconazole and clotrimazole are standard over-the-counter drugs used to treat candidiasis. Tinidazole is used to treat trichomoniasis. Azithromycin is used to treat chlamydia. Metronidazole is used to treat bacterial vaginosis and trichomoniasis.
A nurse is planning to teach a school-aged child with newly diagnosed type 1 diabetes about self-care. After an assessment of what the child knows about diabetes, what is the next nursing intervention? 1 Teaching the child how to perform blood glucose testing 2 Developing a sequence of goals with the child and parents 3 Instructing the child in how to administer insulin injections 4 Establishing a trusting relationship with the child and parents
Negotiation of goals precedes and is essential to successful learning; mutual goal-setting provides a focus for learning. If the child does not identify this need or set a goal, there may be little motivation to learn the task. A trusting relationship should have been established during the assessment phase, before the start of the teaching-learning process.
The mother of a kindergartner tells the nurse that her daughter is constantly scratching behind her ears. The nurse suspects pediculosis capitis (head lice). What does the nurse expect to find during the physical assessment? 1 Small grayish-brown threadlike lines 2 Scaly patches within areas of alopecia 3 Streaked blisters surrounding a larger one 4 White spots attached to the bases of hair shafts
Pediculosis capitis (head lice) are common among enclosed groups of children, especially those in nursery and primary schools. The eggs (nits) adhere to the hair shafts about an inch from the scalp. They are commonly found behind the ears and at the nape of the neck. Brownish lines on the skin are indicative of scabies, which is a mite infestation. Scaly patches in areas with no hair are associated with childhood atopic dermatitis (eczema). Blisters are typical of tinea capitis (ringworm), which is caused by a fungal infection. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
A nurse is teaching a school-aged child with juvenile idiopathic arthritis (JIA) activities to prevent the loss of joint function. What should the nurse caution the child to avoid? 1 Bicycle riding 2 Walking to school 3 Isometric exercises 4 Sedentary activities
Prolonged sitting in one position can lead to stiffness and flexion contractures and should be avoided. Riding a bicycle helps maintain joint mobility, which is advantageous. Walking promotes functional movement and is beneficial. Isometric exercises are beneficial because they help maintain muscle tone. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices.
A 7-year-old child who has sustained frostbite of the toes after skiing in below-freezing weather is brought to the emergency department. What is the nurse's initial intervention? 1 Rapidly rewarming the toes by placing the feet in warm water 2 Slowly rewarming the toes by wrapping the feet in a warm cloth 3 Placing the feet in cool water to minimize the temperature difference 4 Wrapping the feet in an ice pack until definitive medical help is available
Rapid rewarming is accomplished by immersing the body part in well-agitated water at 100° F to 108° F (37.8° C to 42.2° C). Rapid rewarming minimizes tissue damage. The body part should be rewarmed as quickly as possible to minimize tissue damage. Prolonged exposure to the cold will worsen tissue damage.
The parent of a child who has received all of the primary immunizations asks the nurse which ones the child should receive before starting kindergarten. What immunizations does the nurse tell the parent that her child should receive? 1 IPV, HepB, Td 2 DTaP, HepB, Td 3 MMR, DTaP, Hib 4 DTaP, IPV, MMR
Scheduled immunizations for preschool children include diphtheria, tetanus, and pertussis (DTaP), the inactivated polio vaccine (IPV), and measles, mumps, and rubella (MMR) at 4 to 6 years (usually required by law). Hepatitis immunization is given in three doses between birth and 9 months; the tetanus/diphtheria vaccine is given at 7 to 10 years of age, with subsequent doses based on the age when the vaccine was first received. Hepatitis B immunization is not required once immunity is established; administration of a subsequent dose of tetanus/diphtheria vaccine is based on the age when the first dose is received. The Haemophilus influenzae type B (Hib) vaccine is given at 12 to 15 months.
A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The healthcare provider informs the parents that antibiotics are required before any dental work is performed. Later the parents ask the nurse why this is necessary. When responding, the nurse explains that this is done to prevent what type of infection? 1 Gingivitis 2 Pericarditis 3 Myocarditis 4 Endocarditis
The administration of antibiotics before an invasive procedure can prevent subacute bacterial endocarditis, which may occur in children and adults with heart abnormalities. The endocardium is the lining membrane of the cavities of the heart and the connective tissue bed on which it lies. Gingivitis, an inflammation of the gums, frequently is related to the accumulation of food particles in the crevices between the gums and teeth. Antibiotics are not given to prevent this condition, although they may be prescribed in the presence of an infection of the gums. The endocardium is more susceptible to infection than is the pericardium. The pericardium is the fibroserous sac enclosing the heart. The myocardium is the middle layer of the heart wall, composed of cardiac muscle; myocarditis is an infection of the myocardium, which is an unlikely sequela of dental procedures.
A child is admitted to the pediatric unit with a diagnosis of meningococcal meningitis. What does the nurse conclude about isolation? 1 It is unnecessary during the incubation period. 2 It is required for 7 to 10 days until the fever subsides. 3 It will be unnecessary after the diagnosis is confirmed. 4 It will be necessary for 24 to 72 hours after the initiation of antibiotic therapy.
The meningococcal organism is rendered inactive after 24 to 72 hours of antibiotic therapy; isolation is not required after this time. Meningitis is not evident during the incubation period. The presence of a fever is not the influencing factor indicating the need for isolation. After the diagnosis of meningitis is confirmed, isolation is required for 24 to 72 hours after the institution of antibiotic therapy.
A nurse explains the physical sensation that a 13-year-old client will feel when a needle punctures the skin to draw blood. What instructional method would the nurse use? Incorrect 1 Analogy 2 Role play 3 Demonstration 4 Preparatory instruction
The nurse should use preparatory instruction to teach a client about the physical sensation of drawing a blood sample. During this method, the nurse provides information about procedures to decrease a client's anxiety. During an analogy, the nurse uses verbal instruction along with familiar images to make complex information more real and understandable. During role play, clients are asked to play roles to feel more confident while going through the procedure. The nurse uses demonstrations when teaching psychomotor skills such as preparing a syringe, bathing an infant, or walking with crutches.
A 7-year-old child loses consciousness a few days after a traumatic head injury that resulted in a subdural hematoma. While assessing extraocular movements, the nurse notes that the child is displaying the oculocephalic reflex. What does the nurse conclude about the presence of the oculocephalic reflex in an unconscious child? 1 Unusual 2 Expected 3 Suppressed 4 Hyperactive
This reflex indicates the functional integrity of the brainstem in unconscious individuals. Failure of the eyes to lag adequately or to revert to midline on rapid side-to-side movement of the head suggests brainstem damage. It is not unusual in the unconscious child; it is absent in conscious individuals, whose extraocular movements are controlled voluntarily. Extraocular movements are not suppressed in unconscious individuals. This reflex is not hyperactive in the unconscious individual.